CTV is a safe and quick diagnostic tool for detecting DVT in patients with suspected PE. Due to the relevant increase in radiation dose, the indication has to be considered very carefully.

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Purpose: To investigate magnetic resonance imaging (MRI) features of radiation-induced plexopathy (RIP) and radiation-induced fibrosis frequently associated with RIP. Patients and Methods: Seven patients with late radiation sequelae in the supraclavicular region were examined with MRI after a median interval of 7 years (range, 5-18 years) following radiotherapy and 4-7 years after the onset of RIP. Four patients had RIP plus severe soft-tissue fibrosis, two RIP without soft-tissue fibrosis (n = 2/6), and one patient fibrosis without RIP. Patients underwent surgery of breast cancer (n = 6) or chest wall relapse (n = 1) and radiotherapy to the supraclavicular fossa with cobalt with an anterior portal in fractions of 1.7-2.6 Gy to 43-51.6 Gy in 3 cm depth. All patients were relapse-free at the time of MRI. Fibrosis and RIP were scored clinically (RTOG classification). Fibrosis of the supraclavicular and/or axillary region was marked in three and mild in two patients. RIP was mild, marked and severe in two patients each. MRI was performed with a 1.5-T unit including coronal STIR, coronal and transversal T2-weighted, transversal T1-weighted and fat-saturated post-contrast (gadolinium-DTPA) spin echo sequences. Results: The brachial plexus appeared normal in all patients, but subtle changes of adjoining tissue (slight, linear signal intensity in T2-weighted images or contrast enhancement surrounding the plexus) were detected in patients with RIP (n = 4/6) and the patient without RIP (n = 1). However, alterations of the soft tissue (marked signal intensity in T2-weighted sequences) correlated well with the clinical degree of fibrosis and were restricted to areas of marked to severe fibrosis (n = 3/3). Conclusion: Reliable MRI signs of RIP could not be identified. The severity of fibrosis closely corresponded to MRI features. The role of MRI in the diagnostic work-up of RIP is, therefore, the exclusion of tumor relapse.Ziel: Die Darstellung der radiogenen Schädigung des Plexus brachialis (RP) und der häufig mit der RP assoziierten Weichteilfibrose mit der Magnetresonanztomographie (MRT) wurde untersucht. Patienten und Methodik: Sieben Patientinnen mit ausgeprägten Strahlenreaktionen in der Supraklavikularregion wurden median 7 Jahre nach Therapie untersucht. Vier Patientinnen hatten eine RP und Fibrose, zwei Patientinnen eine RP ohne Fibrose und eine Patientin eine Fibrose ohne RP. Im Rahmen der Primärtherapie (n = 6) bzw. nach Exzision eines Brustwandrezidivs (n = 1) wurde die Supraklavikularregion mit 60 Co in Einzeldosen von 1,7-2,6 Gy bis zu einer Gesamtdosis von 43-51,6 Gy in 3 cm Tiefe bestrahlt. Die Patientinnen waren seit mindestens 4 Jahren rezidivfrei. Fibrose und RP wurden klinisch nach RTOG klassifiziert. Die MRT-Untersuchung wurde an einem 1,5-T-Gerät mit koronaren und transversalen T2-gewichteten Sequenzen, koronaren STIR, transversalen T1-gewichteten Sequenzen und fettgesättigten Spinechosequenzen nach Kontrastmittelgabe (Gadolinium-DTPA) durchgeführt. Ergebnisse: Der Plexus brachialis selbst stellte sich ...

Angiography should be performed in patients with spontaneous and postoperative gastrointestinal bleeding. Transcatheter embolization is an effective and safe therapeutical option in both clinical settings.